Signed, Sealed, Delivered….To A Vital Statistics Near You!

Physicians and funeral directors have something in common…

…and local and state Vital Statistic agencies want that “something” but can only wait for so long.

That something …(surprise)….is the Death Certificate, the legal proof of that final earthly human milestone and so much more!

Funeral Directors have the State mandated responsibility to:

  • obtain identifying and demographic information from the deceased’s next-of-kin,
  • enter it on death certificate (DC) ,
  • notify the certifier of death (i.e. the physician) of the need to enter the medical cause of death on the DC,
  • and file the DC with local and state vital statistics departments or bureaus.

… all in about 5 days if all goes well 1 .

Did you know? The certifier of death is any physician who treated the decedent within 12 months preceding the death or his/her associate physician, the chief medical officer of the institution, or the physician who performed the autopsy ( i.e. the hospital or forensic pathologist) 2 .

Physicians must enter the medical cause of death within 48 hours. If it cannot be entered within the specified time (usually because medical records and test results need reviewing or the autopsy results aren’t back yet), then “Pending test results”, “Pending autopsy results” , or simply “Pending” must be entered on the DC. Once records and results are reviewed, a supplemental DC listing the final cause of death must be promptly done. It is UNACCEPTABLE to list “Unknown” as a cause of death.

Says who?

The State within which you are employed or your medical board 3 .

The medical cause of death can be entered on paper or online via the secure electronic death registration system (EDRS) set up by the majority of States. The creation of this system was by the diligent and coordinated efforts of many including physicians and public health professionals under the National Association for Public Health Statistics and Information Systems (NAPHSIS) 4 . The EDRS facilitates faster access to DCs used in processing of insurance, benefits, and property claims. The EDRS system also makes data more quickly available for important public health and administrative needs including reporting, analysis, and surveillance 5 .



  1. Funeral Directors’ Handbook on Death Registration and Fetal Death Reporting. 2003.US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Available at: .
  2. Model State Vital Statistics Act, 2011 Revision. Available at: .
  3. State Medical Board of Ohio Policy Statement: Regarding the Signing of Death Certificates by the Attending Physician.
  4. NAPHSIS. Electronic Death Registration System. .
  5. Armstrong EJ. Chapter 8: The Clinician Certifier of Death. In: Essentials of Death Reporting and Death Certification: Practical Applications for the Clinical Practitioner. 2017. Publisher E J Armstrong MD. Available at: .

Due to a concern for PPQ Withdrawal Syndrome (AKA PPQWS), a quizlet has been prescribed for you below! It is strongly recommended for clinician certifiers and is PRN. It has no harmful adverse effects and should be shared freely with fellow clinical colleagues:

  1. Case scenario: A 59 year-old female is found unresponsive at home. She has a history of uncontrolled hypertension, COPD, aortic dissection, and non-compliance with her prescribed medication regimen. She is conveyed via EMS to the local hospital whereupon clinical evaluation with imaging reveals an intracerebral and intraventricular hemorrhage consistent with a hypertensive stroke. Foul play and trauma is ruled out and there is no history of substance use disorder or concerns for suicidal tendencies. She is treated by expires and is pronounced deceased within 24 hours of admission. She has a primary care physician and several physicians were involved in her diagnostic clinical work-up during the terminal admission.

True or False: This is a death that is reportable to the Medical Examiner or Coroner (ME/C)?

True or False: This is a case that needs a medicolegal death investigation (i.e. this is an ME/C’s case)?


Stay tuned for the solution to this brain-teaser and the next installment of Practice Pearls!

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